What is elder abuse? an all-inclusive term representing all types ofmistreatment or abusive behavior towardolder adults (Wolf, 2000, p.7) further defined as acts of commission(intentional behavior) and omission (failure toact) self-neglect is the most common form of elderabuse and the most difficult to detect andtreat (Levine, 2003 and Reynolds Welfel et al., 2000)
Types of Abuse Physical Psychological Sexual Material Violation of Rights Medical Abandonment Neglect Self-neglect
Forms of AbusePhysical - hitting, pushing, slapping, punching,restraining, pinching, force-feeding, physicalrestraintPsychological - verbal aggression, intimidation,threats, humiliationSexual - any kind of non-consensual sexualcontact
Forms of Abuse (continued)Material - theft of cash or personal property,forced contracts, misuse of income or otherfinancial resourcesViolation of Rights - deprivation of anyinalienable right such as voting, assembly,speech, privacy, personal libertyMedical - withholding medication orovermedicating
Forms of Abuse (continued)Abandonment - desertion of an elderly person forwhom one has agreed to care for, “dumping” acognitively impaired elder at an emergencyroom with no identificationNeglect - failure to provide necessary physical ormental care of an elderly personSelf-neglect - behavior that threatens one’s ownhealth or safety
Indications of AbusePhysical - multiple fractures or bruises at variousstages of healing, burns, patterned injuries,patchy hair loss, frequent visits to ER, delay inseeking medical treatment for injuriesPsychological - withdrawn behavior, wasting orfailure to thrive, depressionSexual - genital injury, vaginal or rectal bleeding,bruises, chipped teeth, sexually transmitteddisease or infestations
Indications of Abuse (continued)Material - unexplained loss of income, assets,possessions, not eating, missed utilitypaymentsViolation of Rights - isolation, failure to attendchurch services or community events as onedid previouslyMedical - no improvement in condition for whichone was prescribed medication, blood testsindicate greater or lower than expected levelsof medications, sleepiness, groggy
Indications of Abuse (continued)Abandonment - isolation, not seen outside home,disrepair or unkempt environment, missedmedical or other appointments orengagements, wandering, being leftsomewhere to fend for selfNeglect - uncared for appearance, inappropriateclothing, failure to thrive, lack of medical ordental care, isolationSelf-neglect – (similar to neglect)
Scope of the Problem estimates of the occurrence of elder abuse varywidely— due in part to the variability in thedefinitions used to measure and report abuse “mistreatment of adults, including abuse, neglect,and exploitation, affects more than 1.8 millionolder Americans” (Pavlik, Hyman, Festa, Bitondo, and Dyer,2001, p. 45) self-neglect accounts for one-third to one-half ofall abuse cases (Gray-Vickrey, 2000, 2004; Levine, 2003; Paris,2003)
Distribution of Abuse distribution of abuse according to sex wasreported by Wolf (2000) to be almost equallydivided between males and females Some studies indicate that females are moreoften victims of elder abuse (Bratteli2003, Pavlik et al.,2001) Patterns of abuse are similar among AfricanAmericans, Latinos, Caucasians, and Asians(Cavanaugh & Blanchard- Fields cited in Etaugh & Bridges, 2004)
Perpetrators of Abuse elder abuse can be perpetrated by nearlyanyone including paid or volunteercaregivers, medical and long-term careemployees, family members, significantothers, and in some cases strangers such asa person who befriends an elderly person forthe purpose of exploiting them (Reynolds Welfel etal., 2000)
Greatest Risk Factors for CausingAbuse in North Dakota being male under age 60 being related history of mentalillness recent decline inmental health abusing alcohol primary caregiver lives with or hasaccess to the adultthey abuse change in familyroles from beingcared for to beingthe care provider prior history ofviolence (Bratteli, 2003)
Theories Explaining Elder Abuse affects of caregiverstress (situationalmodel) dependency of elderon caregiver(exchange theory) mental or emotionaldisturbance ofcaregiver(psychopathology) repeated cycle ofviolence (sociallearning theory) power imbalance inrelationships(feminist theory) marginalization ofthe elderly withinsociety (politicaleconomic theory)
Risk Factors for Being Abuses Poor health Inability to performactivities of dailyliving Cognitive impairment Living with others(living aloneincreases risk forfinancial and self-abuse) Social isolation Depression,confusion, substanceabuse ordependence Mental or physicalimpairment (stroke,incontinence,Alzheimer’s) Being female Over age 85
Risk Factors for Perpetrating Abuse History of family violence Disruptive behavior on behalf of the carerecipient Mental illness Alcohol or drug abuse or dependence Caregiver dependence
Perpetrating Risk Factors (continued) Stress Physical or emotional exhaustion Low social integration and/or unemployment Lack of community supports Insufficient income for basic needs
Protective Measures Stay sociable and active Stay involved with neighbors, friends, churchor community activities Get regular medical and dental care Open and post your own mail Increase social network as you age Have friends visit you at home Have a “best friend” with whom you canconfide in Keep in touch with old friends if you move
Protective Measures (continued) Keep your possession organized Tell someone you trust where your importantpaperwork and bank account information iskept Have checks direct deposited into youraccount Use an answering machine to screen phonecalls Don’t leave cash or valuables visible Notify the police if you will be away from homefor an extended time period
Protective Measures (continued) Consult with an attorney Make arrangement for the future such aspower of attorney Get legal advise before making/signingagreements regarding your care orpossessions Be aware of your financial situation
Protective Measures (continued) Know where to ask for help Find out about community resources beforeyou need them such as rape and abusehotlines, senior centers, and adult protectiveservices mental health service centers crisis centers private counselors clergy local police
Detection and Treatment Barriers detection of elder abuse is difficult becausedenial is an integral feature of abuse, victimsmay feel too ashamed to disclosemaltreatment or believe they are to blame foror deserve the abuse dependence on an abuser can make a victimreluctant to report for fear of how he/she willsurvives without the perpetrators help
Detection/Treatment Barriers (continued) victims may not define their situation asabuse especially in a dysfunctional familyenvironment where violence or mistreatmenthas been “normalized” (Brown et al., 2004, Levine,2003) cognitive, auditory, speech, visualimpairments, isolation or restraint may makereporting impossible for the victim of elderabuse
Detection/Treatment Barriers (continued) ageism can negatively affect detection ofelder abuse as it is common to view theelderly as confused or demented, to trivializeelders’ complaints, and to adhere to theperception that elder abuse doesn’t exist physical injuries may be masked by clothingor by isolating the victim
Detection/Treatment Barriers (continued) fast paced medical services and heavycaseloads of social service providers may notallow time for adequate assessment basic lack of information of where to turn forhelp impedes the intervention and treatmentfor both perpetrator and victim of abuse
Recommendations further research using standardizeddefinitions and subtypes of elder abuse wouldprovide a better picture of the scope of theproblem improved reporting guidelines along withincreasing the number of agencies and theirfunding is essential.
Recommendations (continued) Greater understanding of the causation ofelder abuse could lead to the development ofeffective treatment programs for abusers defining elder abuse in its own terms ratherthat modifying guidelines from child abuselegislation would improve the understandingof elder abuse as a phenomenon separateand unique from child abuse
References Bratteli, M. (2003). Caregiver abuse, neglect andexploitation: The journey through caregiving. NorthDakota State University. Brown, K., Streubert, G., & Burgess, A. (2004).Effectively detect and manage elder abuse. TheNurse Practitioner, 9 (8), 22-33. Etaugh, C. & Bridges, J. (2004). The psychology ofwomen: A lifespan perspective (2ndEd.). Boston, MA:Pearson Education, Inc. Gray-Vickrey, P. (2000). Protecting the older adult:Learn how to assess the visible and invisibleindicators and what to do if you recognize abuse inan older patient. Nursing, 30 (7), 34-38.
References (continued) Gray-Vickrey, P. (2004). Combating elder abuse:Here’s what to look for, what to ask, and how torespond if you suspect that an older patient is avictim. Nursing, 34 (10), 47-51. Kapp, M., (2004). Family caregivers’ legal concerns.Family Caregiving, (winter) 2003-2004, 49-55. Lachs, M., & Pillemer, K. (2004). Elder abuse:Seminar. www.thelancet.com, 364 (October), 1263-1272. Levine. J. (2003). Elder neglect and abuse: A primerfor primary care physicians. Geriatrics, 58 (10), 37-45. Paris, B. (2003). Abuse and neglect: So prevalent yetso elusive (editorial). Geriatrics, 58 (10), 10.
References (continued) Pavlik, B., Hyman, D., Festa, N., & Bitondo Dyer, C.(2001) Quantifying the problem of abuse and neglectin adults—analysis of a statewide database. Journalof the American Geriatrics Society, 49, 45-48. Reynolds Welfel, E., Danzinger, P., & Santoro, S.(2000). Mandated reporting of abuse/maltreatment ofolder adults: A primer for counselors. Journal ofCounseling & Development, 78 (summer), 284-292. Wolf, R., (2001). Introduction: The nature and scopeof elder abuse. Generations, Summer, 6-12.
Resources Aitken, L. & Griffin, G. (1996). Gender issues in elderabuse. Thousand Oaks, CA: Sage Publications, Ltd. Journal of elder abuse & neglect. HaworthMaltreatment & Trauma Press. Quinn, M. & Tomita, S. (1997). Elder abuse andneglect: Causes, diagnosis, and interventionstrategies (2ndEd). New York, NY: Springer PublishingCompany. Tatara, T. (1999). Understanding elder abuse inminority populations. Philadelphia, PA:Brunner/Mazel (a member of the Taylor & FrancisGroup).